Incidence, mortality, and risk factors associated with carbapenem‐resistant Acinetobacter baumannii bacteremia within 30 days after liver transplantation

Abstract

Carbapenem‐resistant Acinetobacter baumannii bacteremia (CRAB‐B) is a fatal infectious complication of liver transplantation (LT). This study investigated the incidence, effects, and risk factors associated with CRAB‐B during the early post‐LT period. Among 1051 eligible LT recipients, 29 patients experienced CRAB‐B within 30 days of LT with a cumulative incidence of 2.7%. In the patients with CRAB‐B (n = 29) and matched controls (n = 145) by nested‐case control design, the cumulative incidence of death on days 5, 10, and 30 from the index date was 58.6%, 65.5%, and 65.5%, and 2.1%, 2.8%, and 4.2%, respectively (p < .001). Pre‐transplant MELD (OR 1.11, 95% confidence interval [CI] 1.04–1.19, p = .002), severe encephalopathy (OR 4.62, 95% CI 1.24–18.61, p = .025), donor body mass index (OR .57, 95% CI .41–.75, p < .001), and reoperation (OR 6.40, 95% CI 1.19–36.82, p = .032) were independent risk factors for 30‐day CRAB‐B. CRAB‐B showed extremely high mortality within 30 days after LT, especially within 5 days after its occurrence. Therefore, assessment of risk factors and early detection of CRAB, followed by proper treatment, are necessary to control CRAB‐B after LT.

Epidemiology and Prevention of Early Infections by Multi-Drug-Resistant Organisms in Adults Undergoing Liver Transplant: A Narrative Review

“…CRAB is extremely difficult to eradicate from healthcare facilities, frequently causing nosocomial outbreaks [ 44 , 60 , 61 , 62 ]. For this reason, its epidemiology deeply varied not only between different geographical regions, but also among hospitals in the same areas and wards in the same hospital.…”

“…Shi et al [ 57 ] reported that 62% of the A. baumannii isolated from blood cultures in their cohort was MDR. Therefore, post-LT CRAB infections have high mortality rates of 50–65% [ 44 , 60 , 61 , 62 ].…”

“…A Chinese cohort [ 34 ] reported 21 cases of CRAB (11.8%) among 178 post-LT pneumonia isolates. Another cohort study conducted in China by Min et al [ 60 ] reported a 2.8% prevalence of CRAB bacteriaemia within 30 days post-LT, with cumulative mortality incidence on days 5, 10, and 30 from the index positive blood culture date, of 58.6%, 65.5%, and 65.5%. Independent risk factors for 30-day CRAB-bacteriaemia included pre-transplant MELD, severe encephalopathy, lower donor body mass index, and reintervention.…”

Multidrug-resistant organism bloodstream infections in solid organ transplant recipients and impact on mortality: a systematic review

“…Within these limits, crude mortality due to MDRO BSI ranged from 15.4% (VRE 30-day mortality in liver transplant recipients) (20) to 82.4% (CRE mortality in liver transplant recipients admitted to intensive care) (21). Excluding patients in the intensive care setting, crude mortality remained as high as 65.5% (CRAB 10-and 30-day mortality in liver transplant recipients) (22). Where mortality due to MDRO BSI was assessed alongside drugsusceptible BSI, MDRO BSIs were consistently associated with a higher mortality rate irrespective of MDRO or transplant type (Table 2).…”

How to treat severe Acinetobacter baumannii infections

“…Up to one-third of bacteremic Acinetobacter baumannii infections (ABI) patients progress to septic shock, associated with a high mortality rate of 20–60% of cases [19–23,24 ▪ ].…”